Healthy partnerships

NORTH COUNTY -- Getting quick medical treatment for minor
ailments without an appointment got a lot easier for residents of
Oceanside, Poway and Rancho Bernardo last week, when a type of
medical office new to the area opened inside three local CVS
pharmacies.

The new businesses were among six retail health clinics that
Minneapolis-based MinuteClinic launched simultaneously in San Diego
County, with plans for at least 10 more by the end of the year.

The retail health clinics are staffed with family nurse
practitioners who can treat and prescribe medications for
influenza, ear infections and other common illnesses on a walk-in
basis, seven days a week. A limited menu of vaccinations and
diagnostic checks also are available.

The clinics are open well beyond normal business hours and on
weekends. Patients pay $30 to $93 for the clinics' services, with
most priced at $59, and MinuteClinic works with about a dozen
insurers with patients in San Diego County.

The company appears to be riding a health care wave that is
about to deluge the region.

Palomar Pomerado Health and Albertsons announced their own plans
this week to open two retail clinics in North County in early
2008.

The joint-venture businesses, called PPH expresscare, will
operate inside Albertsons/Sav-on Pharmacy stores in Escondido and
Rancho Penasquitos, said Stonish Pierce, manager of clinical
outreach services for the public hospital district.

A third partnership -- between Lindora Health and Rite Aid -- is
preparing to open a set of five retail health clinics in San
Diego-area Rite Aid stores within the next six months. One of those
new businesses, called Lindora Health Clinics, will be in
Encinitas, company spokesman John-Paul Incorvaja said.

Tom Gehring, chief executive officer of the San Diego County
Medical Society, said its members see pluses and minuses to the
retail health clinic idea, with convenience and often-lower prices
among the big positives. Using his 10-year-old son as an example,
Gehring said that he now has three choices if the boy wakes up with
an ear infection on the weekend.

"I could take him to the ER and wait a bizillion years and pay a
bizillion dollars, go to urgent care … or take him to a nurse
practitioner," he said. "So this is a rational response to a
legitimate economic and medical need."

Gehring said medical society members are concerned, however,
that patients with serious medical problems will try to use the
retail clinics, putting their staff members in the position of
trying to treat illnesses and conditions they are not trained to
handle.

"What we have to do with this is make sure people understand
what are the limits of these types of clinics -- patients and the
people (working) in the clinics," he said.

All the retail clinics have agreements with physicians who will
review the medical records of people treated at the businesses.
Noting that nurse practitioners recently tried unsuccessfully to
get state legislators to ease restrictions that require such
oversight, Gehring said the medical society also wants to see the
oversight requirement maintained at its current level.

MinuteClinic Chief Financial Officer Kent Lillemoe, whose
company is making its first push into California after successfully
operating retail health clinics in 24 other states, said the
businesses really are designed for busy consumers suffering from a
short list of common illnesses that nurse practitioners are trained
to diagnose and treat.

"If it's broken, bleeding or chronic in nature, that's not the
focus of our business," he said. "We think of ourselves as more of
an adjunct to the primary care physician or the emergency room --
where if it's a minor illness that is acute care in nature, we
offer the convenience in both access as well as (waiting) time to
come in and confirm that you have or do not have what you think you
have."

Dr. Don Herip, medical director for corporate health at Palomar
Pomerado, said the scope of services that will be offered by its
350-square-foot retail health clinics will also be limited. Like
MinuteClinics, PPH expresscare clinics will encourage patients who
do not have primary care physicians to get them and forward
information about patients' clinic visits to their own doctors
electronically within a couple of days of their treatment, to
ensure continuity of care, he said.

"The retail clinic is not urgent care and not meant to replace
your primary care physician," Herip said. "These are walk-in health
centers with no appointment (necessary). … You're looking at strep
throat, pink eyes, coughs and colds, select vaccinations and
physical exams for kids going back to school and athletics."